Atlas of Diagnostic Pathology (9) : Hepatobiliary System 2: Liver Biopsy Interpretation

Liver biopsy is the basic tool to diagnose and evaluate the severity of liver disease. For chronic liver diseases, knowing the stage of liver fibrosis is essential to determine the prognosis and make appropriate treatment decisions. Liver biopsy is currently the gold standard for assessing liver fibrosis; however, the method is invasive. The interpretation of a liver biopsy demands an experienced liver pathologist, and even clinicians are required to understand the reports of liver biopsies. To avoid preconceptions, pathologists should study liver slides before any clinical information is obtained. In all instances, a morphologic diagnosis should be made first. By definition, a diagnosis should not be changed because of subsequent biochemical, clinical, or other non-morphologic information. Proper morphological assessment of liver biopsy specimens must include the following individually examined features: portal tract which includes portal vein, hepatic arteriole, intra-lobular bile duct, inflammatory cells, fibrosis, limiting plate and parenchyma which includes hepatocytes, inflammatory cells, necroses, fibrosis, sinusoids, and central veins. The final morphological diagnosis is made after the evaluation of these morphological assessments